The challenge of globalization could be the burning platform on which Canadian health providers finally learn that there is more to gain from collaboration than competition. Change in this globalized world cannot mean morphing into (publicly funded) entrepreneurial organizations and competing among other Canadian institutions prospecting for their global market share. Hospitals must understand that if they are firstly integrated into a proper, seamless healthcare system, they could then have extraordinary power in a globalized world. The VISA model should be examined as an example of the collaboration and co-operation that has allowed thousands of highly competitive financial institutions to come together with a common governance structure and an IT system that benefits everyone. VISA is doing very well in a globalized world.

Perhaps it is because of our hospital-centric approach to acute care that we have continued to view healthcare as simple or merely complicated instead of as a complex, adaptive system. Only by focusing on creating a "real" healthcare system here in Canada with the patient in the centre will we be able to ensure that Canadians will receive the benefits of globalization and that Canada will, as Commissioner Romanow said in his report, "take an international leadership role in sharing its expertise and helping developing countries improve their healthcare systems and the health of their people."

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